Hallux valgus, more commonly known as bunions, is a condition where the first metatarsal deviates inward toward the second metatarsal. This results in an intermetatarsal angle that is too large. Bunions are caused when certain tendons, ligaments, and supportive structures of the first metatarsal no longer function correctly causing the first metatarsal to be misaligned. Bunions may be caused by a variety of conditions intrinsic to the structure of the foot, such as flat feet, excessive ligamentous flexibility, abnormal bone structure, and certain neurological conditions.
Bunions are commonly associated with arthritis of the first metatarsal, diminished and/or altered range of motion and discomfort when pressure is applied to the first metatarsal or with motion of the joint. Treatments of bunions vary and, depending on severity of the misalignment, can range from rest, medication, orthotics and, in extreme cases, surgery.
Numerous techniques have been used during surgery to correct the intermetatarsal angle, including the reshaping or removal of part of the first metatarsal bone. Other techniques have also been used to reduce the intermetatarsal angle to a normal angle of less than 9° to 11°. One way to reduce the intermetatarsal angle is by connecting the first and second metatarsals together with a suture, to secure the first metatarsal at a proper angle.
One such technique for hallux valgus repairs employs a suture-button construct as detailed in U.S. Patent Publ. No. 2008/0208252 (filed on Jan. 17, 2008 and assigned to Arthrex, Inc.). According to U.S. Patent Publ. No. 2008/0208252, a suture strand is double looped through first and second buttons, and a pull-through suture is attached to one of the buttons and to a needle. This technique requires one large diameter hole, drilled through both the first and second metatarsals, to allow passage of the button.
Another technique employs a deconstructed suture-button construct sold by Arthrex, Inc. of Naples, Fla. under the tradename Mini TightRope®. The deconstructed Mini TightRope® technique involves drilling two small drill holes through the first and second metatarsal, and passing sutures through each hole, thereby connecting the first and second metatarsals. This procedure requires a higher degree of technical difficulty, however, since both drill holes must be parallel and in the same plane. What is needed is a simpler technique but with equivalent strength. Also needed is a technique that requires only one small hole in lieu of multiple holes drilled through the first and second metatarsals.